LETTER
Hyperthyroidism
Gordon N. Gill
1 March 1995 | Volume 122 Issue 5 | Pages 393-394
TO THE EDITOR:
In their review, Klein and colleagues [1] state that radioiodine is the "preferred" treatment for Graves disease. Although this is the most frequently chosen form of therapy in the United States, antithyroid drug therapy is most often used in Europe and Japan [2]. Historical, social, and cultural factors underlie, in part, these geographic differences in choices of therapy. Arguments can be made for each form of therapy, but, given the differing practices around the world, radioactive iodine is "preferred" only because it is currently the therapy most widely used by U.S. physicians and not necessarily because it is the most desirable therapy for patient outcomes. In the study by Hashizume and colleagues [3], which dealt with only limited numbers, more than 95% of patients remained euthyroid 3 years after completion of therapy with methimazole plus thyroxine. As Klein and colleagues indicated, this striking result must be confirmed by others, preferably in different locations. Because Graves disease is common, studies must be done so physicians can choose therapy based not on popular preferences but on patient outcomes. Multicenter trials seem the most efficient way to establish "preferred" (that is, desirable) outcome-based therapies [4, 5].
1. Klein I, Becker DV, Levey GS. Treatment of hyperthyroid disease. Ann Intern Med. 1994; 121:281-8.
2. Wartofsky L, Glinoer D, Solomon B, Nagataki S, Lagasse R, Nagayama Y, et al. Differences and similarities in the diagnosis and treatment of Graves' disease in Europe, Japan, and the United States. Thyroid. 1991; 1:129-35.
3. Hashizume K, Ichikawa K, Sakurai A, Suzuki S, Takeda T, et al. Administration of thyroxine in treated Graves' disease. N Engl J Med. 1991; 324:947-53.
4. Lipid Research Clinics Program. The Lipid Research Clinics Coronary Primary Prevention Trial results. II. The relationship of reduction in incidence of coronary heart disease to cholesterol lowering. JAMA. 1984; 251:365-74.
5. DCCT Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1994; 329:977-86.
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